Getting Good Data on the Bad Health of the Homeless

NEVER underestimate the power of suggestion. Spend two minutes inhaling the stale, over-baked air inside Bonnie Kerker's unlovely office in the epidemiology wing at the city health department's somewhat geriatric Worth Street headquarters, and the topic of germs surfaces on autopilot.

Do they proliferate here in the domain of someone whose business it is to collate data -- her most recent effort being to help direct an unprecedented survey of the health, or lack thereof, of the city's homeless adults -- that explain what most ails and, more grisly still, what most kills New Yorkers? Does Dr. Kerker get sick often?

She does not. Probably unwise to go into this line of work if one is leery of communicable diseases. At 37, she is an assistant commissioner for epidemiology services with a Ph.D. in public health from Yale. Actually, with her long, wavy tresses and tall black boots, she looks younger than her years. Data must invigorate her.

"But I think I'm getting an ulcer," she says, playing along with a pair of mild hypochondriacs from the news media. But only momentarily. Dr. Kerker, who envisioned at age 10 that she would someday join the Peace Corps and heal malnourished children in Ethiopia, is a serious soul with a serious job and quickly reverts to type.

"What I most love about this is also what makes it stressful," she says candidly. "Everybody really relies on data in the Bloomberg administration. So you feel like you're needed and like the work that you do is actually being used in policy decisions. That's why I went into this field in the first place. It's hard to find a place that really wants to use data to make decisions."

While it may be career-affirming to work for a mayor with an insatiable appetite for data, Dr. Kerker emphasizes that the stuff has to be unskewed: "It's not just a blind trust in whatever numbers we find." Data without context, she says, is just as misleading as data taken out of context. "I care about details and spend an awful lot of time making sure our data is accurate, and that we portray things in a fair way. The health problems we face in this city can't be solved by just a categorical approach. I'll think about things all night; I admit it, I take my work home with me." She's a worrier.

Hence the crack about her incipient ulcer. And her conviction about the importance of the survey of 100,000 homeless New Yorkers who were clients of the city's shelter system, a joint venture by the Department of Health and Mental Hygiene and the Department of Homeless Services. (It could be a model for other such reports, she says: just think, a peaceful and equitable collaboration between two city agencies.) She is hoping to do a similar study in conjunction with the Department of Correction and would love, she says, to be of statistical assistance to the city's beleaguered child welfare agency.

She does not dispute that the data on the homeless, compiled by colleagues from 2001 through 2003 and analyzed by her to a fare-thee-well in 2004 -- she hates to get anything wrong -- proved the opposite of uplifting.

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The homeless die at twice the rate of other New Yorkers and account for new H.I.V. diagnoses at a rate 16 times higher than among the general population; in fact, they are in poorer health than health officials, including their own doctors, realized. And the stigma of the homeless as diseased, marginal beings was inadvertently reinforced.

"It's unclear whether homelessness comes before poor health or poor health comes before homelessness," she admits. "That's sort of a chicken and egg thing. The new H.I.V diagnoses, that sort of blew people's minds. Our job is to try and minimize the stigma -- to balance the worry that the data may cause with what we can now do to try and improve the health of a very vulnerable population. To have the data by themselves is sobering and depressing, but having the data and an action plan, which we have, is encouraging. The wheels are already turning."

Rapid H.I.V. testing, detoxification programs at shelters and nicotine replacement therapy, all of which the city said it would do in response to the findings, are, she says, the bright side of some dark data.

WHEN you provide data for good decision-making, it can produce a positive," she says. "Homeless Services is trying to end chronic homelessness; we're trying to improve the health of the homeless. We're both focused on the best method for bringing health services to this population."

She grew up in Rockland County in New City, where her father was a lawyer and her mother taught school. After college at Tufts, she joined the Peace Corps, and spent two years, not in Ethiopia, but in the Dominican Republic developing community health and education programs in Sabana Alta, a village of 8,000. She joined the city health department in 1995 as an epidemiologist, returned to Yale for her doctorate, and was rehired in 2003 to analyze data and help write a report on health disparities in New York City.

She lives in Brooklyn, dotes on her three nephews, and keeps fit by running and hiking; she is a vegetarian, but not for data-related reasons. In 1990, as part of her Peace Corps training, she had to kill, pluck, clean and cook chickens from the tame flock that wandered through her village and occasionally were generous enough to lay eggs in her bed.